Fee-For-Service Payment. (FFS) - (1) the maximum Fee-For-Service rate determined by DHCS for services provided under the Medi-Cal Program; or (2) the rate agreed to by PARTNERSHIP and Provider. All Services that are Non Capitated Services or authorized by PARTNERSHIP pursuant to this Agreement will be compensated by PARTNERSHIP at the lowest allowable Fee-For-Service rate unless otherwise identified in Section 4 of this Agreement.
Fee-For-Service Payment. Plan shall pay Contractor for Covered Services provided to Healthy Families Members at the Fee (defined below) less twenty-five cents ($0.25). , Payment may be subject to adjustment as described in Section 3.3 of this Agreement, is subject to the Coordination of Benefits rules set forth in Section 3.5 of this Agreement. The remaining twenty-five cents ($0.25) of the Fee will be held in reserve to absorb possible cost overruns in the Healthy Families Pharmaceutical Covered Benefits Account. Compensation to Contractor for Covered Services provided to Healthy Families Members shall be reduced by any applicable owed by or on behalf of such Healthy Families Members.
Fee-For-Service Payment. The Minister will only access the Service Provider’s Services for Individuals, under this Agreement, upon the Minister sending a Referral Confirmation regarding an Individual to the Service Provider. The Referral Confirmation attached as Schedule F, will demonstrate the intent of the Minister to purchase defined Services from the Service Provider and will indicate the payment rate per Individual for the types of Services as described in Schedule A, and is subject to the terms of this Agreement. The total amount of Direct Service Costs payable to the Service Provider under this Agreement will fluctuate based on changes to the number of Individuals served. The Minister agrees to pay the Service Provider a total sum for Direct Service Costs up to $_____________, (“Direct Services Total Amount”) as set out in Schedule A, Article VI, for providing Services to Individuals, on a fee for service basis. Payment for the performance of Services in this Agreement shall be made only upon receipt of Service Provider Invoices, completed in the format attached as Schedule B, and the Service Provider shall ensure that each Invoice which is submitted to the Minister: is as accurate and up to date as possible; is submitted within twenty-five (25) Business Days following the end of the month in which the Services were performed or the end of the month in which this Agreement terminates or expires. All Referral Confirmations used to support the invoicing of Direct Services must be retained by the Service Provider, and produced upon request by the Minister, to verify that billing for Services provided, was accurate. The Minister will not pay the Service Provider for any Services that cannot be substantiated by Invoices and any documentation directly related to the Services provided under this Agreement, including Referral Confirmations.
